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General NPI Number Information
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NPI Number | 1255017828
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Entity Type | Individual
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Provider Name | TIMOTHY MARVIN WILSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 1820 ROANE STATE HWY
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City | HARRIMAN
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State | TN
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Zip | 37748-8307
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Country | US
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Telephone | 865-717-9496
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Fax | 865-717-9928
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Provider Business Mailing Address
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Address Line | 1820 ROANE STATE HWY
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City | HARRIMAN
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State | TN
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Zip | 37748-8307
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Country | US
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Telephone | 865-717-9496
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Fax | 865-717-9928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 47108
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47108
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License Number State | TN
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